Friday, October 30, 2009

Okay, Grumpyites, the following quote was uttered to me by a drug rep about 5 minutes ago:

"So, Dr. Grumpy, you know, I came in because I'd like to know, you know, what you, like, know about our new product, and what your patients know about it, and, like, what you think about it, and all that stuff, like that, you know?"

Before an appointment ends I always ask patients if they need any refills or scripts written. It saves time later.

So yesterday I asked Mrs. Brainless if she needed any refills on her seizure medication, and she said no.

Last night, around 9:00, a pharmacist called me. Mrs. Brainless was there, needing a refill on her med. The same one I'd offered to refill earlier (for the record, she told the pharmacist it was "my seizure pill, whatever it's called". Fortunately, they know her there and could look it up).

I authorized the refill, then called her cell phone (1-800-BRAINLESS), and asked her why she'd told me she didn't need any refills a few hours earlier.

"I didn't then. I still had one pill left for my night dose. But I took it, and now I'm all out, so I'll need some for tomorrow morning".

Thursday, October 29, 2009

Late this afternoon Annie came looking for me. She'd just gotten off the phone with our branch of BigBuck Bank. Britney, an account manager, had called and said she needed to talk to me about the Grumpy Neurology, Inc. account.

Since I'm not one to screw around with the financial health of my business, I called her back between patients.

Britney: "BigBuck Bank, this is Britney."

Dr. Grumpy: "Hi, this is Ibee Grumpy, returning your call."

Britney: "Oh! Thank you for calling me back so quickly. I was reviewing your account, and found you qualify for a BigBuck Bank corporate Visa card!"

(pause)

Dr. Grumpy: "I already have a BigBuck Bank corporate Visa card."

(longer pause)

Britney: 'You're right! Thank you for calling me back, and have a nice day!"

Dr. Grumpy has now had his H1N1 vaccine. And I have to say that I'd have preferred a shot to the H1N1 vaccine I got, which involved having a few drops of liquid sprayed up each nostril.

It tickled like hell, and made me sneeze constantly for the next 5 minutes. I'm pretty sure that anyone who'd like to be vaccinated could get treated by licking my desk, phone, pens, and anything else that was in front of me during my sneezing fit.

Wednesday, October 28, 2009

"I have good insurance! Why should I pay for somebody else's medical care?"

I hear crap like this everyday. Somehow people really believe this, too.

GET REAL PEOPLE! YOU PAY FOR IT NOW! AND GUESS WHAT? THERE IS NO MODEL OF HEALTH CARE WHERE YOU WON'T!!!

Let's look at this: Mr. Poorsap has no insurance. Maybe he's unemployed. Or an illegal immigrant. Or he's working his ass off, but his job doesn't give him benefits.

Mr. Poorsap has a heart attack. Or gets cancer. Or falls down a manhole. Whatever. He goes to Local ER, and needs to be admitted. Legally, Local Hospital can't turn him away.

He's sick as shit. He needs surgery, maybe more than one. A lot of medications. He has a lot of tests. And a few complications. He's in the hospital for a month before he's finally able to go home.

His bill is $1 million dollars (hypothetical number). There's no way in hell he'll ever be able to pay a significant portion of that.

Local Hospital has to pay the nurses who took care of him, and the companies who sold them medical supplies and drugs to take care of him. They really can't afford to write off that $1 million. So they raise the rates on EVERYONE who comes to the hospital, to help offset the costs of the uninsured.

So they send all these bills to Giant Insurance, Inc., who pays them. Of course, Giant Insurance, Inc. has staff and rent and office supplies to pay for. They need to make-up the money to offset their losses on what the hospital charged them to make up their uninsured patient losses. And so Giant Insurance, Inc. passes the increased costs on to YOU, by raising your premiums.

And multiply this by tens of thousands uninsured Mr. Poorsaps every day, across the country.

Look at this like shoplifting, people: I don't shoplift (well at least not non-Diet Coke items), and I hope you don't shoplift. But somebody does. So if over the course of a year Local Grocery loses $100,000 to shoplifting, they need to make up that loss by increasing their prices. And we ALL pay those when we go grocery shopping.

So regardless of whether you oppose or support the current plans, or voted red or blue, the bottom line is that YOU ALREADY DO, AND ALWAYS WILL, pay for someone else's insurance. The only people who don't are the ones who have no coverage in the first place. Any politician on either side who tells you otherwise is full of shit.

This is a standard model of business (and health care is a business), and has been since the first business opened its doors a long time ago. You have to make up your losses somewhere.

Tuesday, October 27, 2009

My esteemed colleague over at The Angry Pharmacist put up an excellent post a few days ago. I want to direct everyone's attention over to it. He makes some valid points and backs them up with reasonable arguments, and I think it's worth reading.

AND

What makes health care reform so hard, and so scary, is stupidity on both sides.

I missed this story when it first came out, but my awesome reader Lisa was kind enough to send it to me.

Basically a firm called Public Policy Polling surveyed 900 voters here in the USA, asking them if the government should stay out of Medicare.

To my horror, 39% said "Yes"! So, more than a third of eligible voters are entirely unaware that Medicare IS a government program, and always has been.

This poll cut across a frighteningly broad swath of income and education.

At least I get blog material from them.

And a great big DR. GRUMPY THANK YOU TO MY READER LISA K. for bringing this to my attention.

Monday, October 26, 2009

Attention! Alert! Local Grocery has Coke stuff on sale for $2/12-pack!

When this happens I stop by pretty often after work. They only allow you 5 cases per person, so I make repeat trips, with varying combinations of Diet Coke, Coke Zero, and Vault Zero being thrown into my trunk until:

1. My rear tires are squashed flat.

2. My arms fall off.

3. The store runs out

4. I max out my credit card.

So today I was there, deciding what my next soda run should consist of. I was so engrossed in this serious issue that I didn't see it coming.

"I've been aware of the time going by,They say in the end, it's the blink of an eye."

(If you recognize the title- congratulations!

For those who remember, one of my 20+ high school reunions has been coming up, and it was this past weekend. [If you don't remember, I commented on it last month here and here.]

The following is a personal letter I wrote to a friend after my 20th reunion a few years back (he didn't attend). I re-read it last night, and decided my feelings haven't changed since then. So I'm putting it up for your perusal. I should note that in the 20 years prior to the reunion I'd had only incidental contact with anyone from my high school class, except for the one I wrote the letter to.

It was interesting. I didn't go to any of the previous ones, and almost didn't go to this one. But I'm glad I did.

20 years is a long time. It erases a lot of animosity. At some point you find that the majority grew up and became (reasonably) mature, decent human beings. I found there was no competition like there might be at 5 or 10 years. At this point most everyone is set in their lives and has answered the elusive questions of "who am I and what do I want to be?"

Even people who I hated once and never wanted to see again I was glad to see, oddly enough. Instead of being enemies they're now simply people I share a common background with, and it's interesting to talk to them and see where life took them. You don't really have time to sit and talk to anyone for more than a few minutes, because everyone is constantly running to the next vaguely familiar face (or name tag) to say "Hi". Most conversations are long enough to cover your spouse, your job, your kids, and where you've lived in the past 20 years, and then it's on to the next person. In a strange sort of way I imagine an afterlife would be the same way.

I was amazed at how many people came from all over the country just for this, also at how many are on their 2nd and 3rd marriages already. Some have kids who are taking the SAT's themselves. A lot of people (including me) had twins.

Cindy, that girl we were both chasing back then, looked about the same, very thin, same face, just a few more lines. Her short brown hair is now long and dyed raven black. She never married, never had kids, and is still looking for Mr. Right. In fact, she asked me if I knew anyone. I think the whole thing is interesting. As you pointed out in our phone call, she came across as unattainable to everyone back in high school. And now she's the rare one who's still alone.

What's interesting is that on talking to them now, I found that almost all the girls I had crushes on back then are so unbelievably incompatible with me that any relationship with them would have been short-lived, if it had actually happened at all. It's amazing what hormones did then, and what the retrospectoscope shows now.

Ron wasn't there, though he lives locally. Some people had gotten his phone number, but he never returned their calls (said his voice on the machine was still the same, though). No one has had any contact with him for over 10 years, and the ones who had the most recent contact said he'd become very bitter and unhappy, which is why they'd stopped keeping in contact with him. Diane commented that she felt like "he'd become someone who needed rescuing, but nobody else could help him".

Phil and Lisa married and had kids. Phil was an obnoxious jackass in HS. Now I found him to be a polite, decent person who was actually interesting to talk to. He has some sort of administrative job. He's very quiet and down to Earth. Time, raising kids, and having a mortgage and bills has a way of doing that to people. Lisa is now thin as a rail. Phil must weigh 300 lbs.

Pete works locally for an insurance company. He is the same personality as he was then, but pleasant and mature. Not married, no kids. Looks about the same but now has long hair down his back. Mrs. Grumpy, who'd never heard of him before, saw him come in and said "Who is that guy? He looks like the missing link." I think that sums it up.

In high school Pete had this POS 1972 Toyota jeep, that looked like it was about to fall apart. He still has it, was parked next to my car. Oddly, after 20 years, his once-POS 1972 Toyota Jeep is now likely worth more than my 2000 Maxima. Time is a great equalizer.

One of the girls, Laurie, I went back to 6th grade with. Others I went as far back as 4th grade with. The night after the reunion, Laurie was on the local news in a feature story on what it's like to be fighting breast cancer and be raising young children. She hadn't mentioned any of it to anyone there all night.

Sunday afternoon was the final reunion event, a family picnic at Local Park. It was a lot of fun. You realize from watching everyone that the only accomplishments and achievements that really matter to everyone are their kids.

The low-point of the reunion was when I introduced Mrs. Grumpy to Cathy, an old friend from the school paper. Mrs. Grumpy asked her when she was expecting. She wasn't. I told Cathy that Mrs. Grumpy had had too much to drink (actually she doesn't drink at all, but Cathy didn't know that).

We all got a 2-CD set of top hits from our high school days. Scary to think the songs are 20 years old. In front of the ballroom was a table, where several current Local High band students were selling raffle tickets for a fundraiser. Later in the evening I was returning to the ballroom after using the restroom, and the students at the table were looking over the songs on the CD they gave us. They were making comments such as "who is Duran Duran?" and "Boy, I think my dad listens to these guys.".

Perhaps more frightening was when the MC pointed out that when we were in HS "Born in the USA" by Springsteen was released as the FIRST CD SOLD IN THE US.

They had a slideshow going on in one corner the whole night, with various old and new pictures. The most interesting slides:

Arnold Schwarzenegger as Conan the Barbarian then and now as governor.

Michael Jackson on the cover of Thriller, and on his mug shot (remember- this letter was written several years ago).

Madonna then, and still Madonna, now.

In an ironic note, an item on the "Onion" recently was "What did we think we'd be doing with our lives by now:

"1. Dancing professionally2. World famous truck driver3. Overseeing vast empire of some sort4. Making at least assistant manager5. Presenting own line of designer handbags6. Owning a car with gull-wing doors7. Not this telemarketing shit, that's for sure."

It's just amazing how time flies. As cliched as the phrase is, it's really true. When I was 7 and first learned about Halley's comet, the wait for it's next visit seemed like forever. Now, in the blink of an eye, it's been here and gone. My 3 kids are all temporally closer to high school graduation than I am now. Life happens, so enjoy it.

If there was one thing I learned, it was that I wouldn't change anything. You find yourself thinking about all the alternate paths your life might have taken. What if I had asked this girl out, or gone on that trip, or taken that class. I came to realized that if I could go back and do it all over again, I wouldn't change anything. I'm very happy with where life has taken me, and for all the ups and downs of growing up and growing old I wouldn't trade any of it for anything.

Sunday, October 25, 2009

Mrs. Sickandtired: "Yeah, um, I didn't get any sleep last night, because my kids were both up sick, and now I'm exhausted and have a headache and shaky all over."

Dr. Grumpy: "What's your question?"

Mrs. Sickandtired: "Do you think it would help if I got some sleep tonight?"

My inner voice: "No! I think you should stay up all night tonight, too! Stay up for the next week! Make a big pot of coffee and guzzle it! See how long you can go without sleep, and see what it does to you! Suck it up!"

Dr. Grumpy: "Yes, I'd try to get some rest and see how you feel tomorrow."

Friday, October 23, 2009

One of my normally stable Multiple Sclerosis patients (Mike) went south on me today, so I saw him emergently over my lunch hour.

When this happens, the standard treatment is to give high doses of steroids through an IV line for 3 consecutive days. Generally it's done either with home health going to the patient's house to do the infusions, or the patient goes to an outpatient infusion center each day for 3 days to have it done there.

So I got Annie on it fast. Miracle worker that she is, she found both a nursing service and an outpatient infusion center that could do this over the weekend, giving me both options. Then she called the patient's insurance to get approval for one or the other.

Guess what? Mike's insurance company didn't have a supervisor available to authorize either one of these on a Friday afternoon. And the underling Annie spoke to (and then I got on the phone to argue with them) told me she wasn't allowed to give approval for this, and there was no one else around who could. So what did she suggest? She told me to admit Mike to the hospital over the weekend to do this, since that didn't require pre-authorization!

So let's think about this:

Home health OR an outpatient infusion suite would cost roughly $200-$400 per day (including nurse time, supplies, and drug) for 3 days.

BUT since Bozo Insurance, Inc. didn't have some magical person around on a Friday (which is a workday last time I checked) or anyone else who could approve this, they told me to admit Mike to the hospital.

I called a friend in hospital accounting. The rate for the basic room Mike is now in is roughly $1800/day. This does NOT include the costs of drug, supplies, or physician fees for docs having to round on him (since we're required to). All together, the hospital stay will cost the insurance $2500-$3000 per day for 3 days.

And Mike is pissed, too. Because he'd rather be at home.

And this is where your insurance premium dollars are going, and how your insurance company is working hard to cut back on costs and save you money.

The season for sharing is almost upon us, and my kids have started early by sharing some irritating variant of the creeping crud with me.

So in honor of that, I'm going to steal (uh, I mean copy and properly credit) from my esteemed colleague The Mother this excellent post on managing family illness.

She has extensive training in 2 remarkably difficult fields, being both a Mother (of 4 boys) AND a doctor, and so is eminently qualified for all kinds of stuff. Like me, she is a history buff. She can be read at mothershandbook.net.

The Care and Feeding of Illness

by The Mother

Wednesday, October 21, 2009

In the light of the mounting cases of the flu among my bloggy friends, and the fact that, where I live, even DOCTORS can’t get the H1N1 vaccine, I feel compelled to do what I can to make everyone’s lives just a little bit easier during the (nearly mandatory) ten days when the household goes to pieces.

The care and feeding of a sick family, while not an exact science, certainly has a few well-established principles.

1. No wife is allowed to be sick alone. Husband will immediately find a way to be sicker.

2. The child with the most tests that week will get sick first. The child who is in preschool and has absolutely nothing to do with his life (and, because he has nothing to do with his life, MUST be entertained) will miraculously escape disease.

3. They don’t make enough trees for a family of six to all have colds at the same time. Ditto decongestants.

(Corollary to rule 3: You will run out of decongestants within a day. You will buy the biggest box you can legally buy, and then run out in two more days. You will then be forced to beg your neighbor to go to the pharmacy and score you some decongestants. This corollary leads to:

The Mother’s Rule of Decongestant Procurement: Go buy the biggest box you can get, NOW. Set your calendar alarm for one month from now. Repeat, whether anyone gets sick or not.)

4. Even if the mother is on her deathbed, she has to do chores. Someone has to feed everyone and buy toilet paper (and tissues).

(Corollary to rule 4: Everyone gets sick the day before grocery day, when you have no food in the house.)

5. Everyone starts throwing up the minute MOM gets nauseous.

6. Children who are vomiting have an amazing knack of finding the most expensive, least cleanable thing in the house on which to do it.

7. Every sick child regresses at least three years.

8. Husbands who are sick regress to childhood. Somewhere around three or four years of age. The age where they, too, must be constantly entertained.

9. Even with 900+ channels and three televisions, there will be nothing on TV that will keep your children and husband busy for even an hour. Ditto the entire collection of DVDs.

(Corollary to rule 9: The internet gods will pick that week to upgrade their systems, taking down WOW and all of the streaming video sites every five minutes.)

10. (applies only to Jewish households) No matter how much medical education hubby has, he is absolutely convinced that Chicken Soup fixes everything. Sick wife will either be standing over a stove with a pullet or phoning her mother-in-law begging; extra points if she chooses option B.

Wednesday, October 21, 2009

Medicine is a business. Believe me, as a doc in solo practice I REALLY understand that. I want to help people, but also have to pay Mary & Annie, and my mortgage, and Diet Coke bills, and office rent, etc.

In a perfect world, healthcare would be free and unlimited. But our world isn't perfect, and the issue becomes balancing finite dollars against virtually infinite need.

We all try to do our best (I hope) to care for patients within our means.

3. Futile care is often given, usually due to family members feeling guilty. All of us in this business have seen a 90+ year old person with advanced dementia and other serious medical issues, being kept alive with machinery at a family's insistence.

4. Unnecessary admissions for bullshit reasons are common, and a huge waste of resources. My esteemed colleague ERP recently wrote an excellent post on this over at WhiteCoat's Call Room.

5. In my career I've known some system-abusing nurse managers. For example: Years ago I worked at a hospital where one floor's nurse:patient ratio was supposed to be 1:4. Instead, it was often 1:5 or 1:6. This lowered quality of care and increased nurse burn-out, and most docs sure noticed it (I don't go to that hospital anymore).

At a meeting to address these concerns the floor manager was asked why this problem kept occurring. She explained to us that her year-end bonus was based on how far under-budget the floor was, and that she needed to run the floor understaffed because she was trying to afford a down payment on a new car.

6. Some insurance companies have policies where doctors are paid a bonus based on how much care they DON'T do (I don't participate in those contracts). In other words. Big Insurance, Inc., says to Dr. X. "Here is $100,000 (hypothetical number) to pay for all our patients' tests this year. If you only spend $75,000, then you get to keep the other $25,000."

This is grossly unfair. In a perfect world the doctor would ignore this. But it ain't perfect, and we all have bills and families, and so it puts the doc in a difficult situation. And of course, if he doesn't do a test and gets sued, who gets nailed? Not Big Insurance, Inc.

These contracts, fortunately, are in rapid decline. They were most popular during the 90's. But are dying now as more and more docs refuse to accept them.

7. Pay-for-performance (also called P4P). This has been kicked around in the last few years. The idea is simple. Docs who have good patient outcomes will get paid more. After all, shouldn't they be rewarded for being better docs?

The problem here is that some conditions are basically untreatable. And some patients don't care about their own health. If something like this happened, WTF would I want to see someone with something incurable, like Alzheimer's disease? I'd only want to see simple stuff with generally good outcomes, like a young, healthy patient with carpal tunnel syndrome or occasional migraines.

If you've had a stroke, or brain cancer, or something else that ain't so good, then good luck finding a doc who's going to take you on with P4P. Because sick people are only going to cut doctor reimbursements since their outcomes will be worse. And, like I said, in a perfect world docs wouldn't look at the bottom line. But in this world we all have bills and families.

Not only that, but if I beg Mr. Marlboro to quit smoking, and he doesn't, and has a stroke, then I get penalized for a poor outcome that was out of my control.

For P4P to work, it's going to need A LOT of tinkering.

8. And my last whine, and the one that got me thinking to write this:

I got called to ER early yesterday morning to give an older gentleman TPA, the clot-busting drug. He had right-sided weakness, but fortunately got better on his own. Later in the morning, however, he worsened again, then got better again, and kept fluctuating. I kept running back & forth between my office and the hospital as the situation changed. I finally got him stabilized with medications, and ordered a bunch of tests (MRI, MRA, echocardiogram).

About 6 hours after I left the floor, I got called by Dr. Hungry Hospitalist.

Dr. Hungry: "Yeah, this stroke guy. Can I send him home now?"

Dr. Grumpy: "He hasn't had any of his tests yet, has he?"

Dr. Hungry: "No. Can't you just do them as an outpatient?"

Dr. Grumpy: "I'm not comfortable with that. He needs a work-up. His last TIA was only 6 hours ago, and I'm not even sure he's neurologically stable at this point. It's too soon to see."

Dr. Hungry: "I'm sure he's stable. Can't you just see him in your office in a few days?"

Dr. Grumpy: "Why are you so eager to toss him,?"

Dr. Hungry: "Um, well, uh, my, um, year-end bonus is based on how short I'm able to keep my average patient length of stay, and I had a really sick lady a few months ago who was here forever, and blew my average to hell, so I really need to bring it down because I've got a med school loan lump sum payment due in January and..."

Tuesday, October 20, 2009

Ms. Daughter: "Yeah, I need to make an appointment for my Mom, she has Alzheimer's disease".

Mary: "Okay, what about Wednesday at 2:00?"

Ms. Daughter: "No, I need all day Thursday".

Mary: "All day?"

Ms. Daughter: "Yeah, I mean, it's not really an appointment. I've got to drive to Southern City for a business meeting, and need someone to watch my Mom."

Mary: "Uh, we don't do that."

Ms. Daughter: "Come on. The nursing homes charge a fortune for adult day care. Can't I just leave her there for a few hours and you can bill Medicare for an appointment? I'll be back by 4:00, and I'll supply her lunch and insulin."

Mary: "Ummm..., ma'am, we really aren't an adult day care service or care home."

Ms. Daughter: "You won't do this, either? Great. I've tried almost every damn doctor in the area. What is wrong with you people?! Don't any of you care anymore?"

One of her jobs (besides playing Farmtown online) is to fax my notes to other physicians' offices. So late this morning she had a bunch of them to send.

Around 11:30 the girls decided to order lunch from Chipotle, and faxed over an order. Mary went to pick it up.

While she was out I fished the fax confirmation sheet from Chipotle out of the trash, along with some of the medical office fax confirms on my patient notes. I doctored them up to make it look like she'd accidentally faxed all the patient notes to Chipotle. I put them on her desk, and went back to my office.

When she found them she was frantic for about a minute. Then she came back here to kill me.

My cell rings. It's that most dreaded of all numbers, the Local Hospital ER.

Dr. Grumpy: "This is Dr. Grumpy."

Clerk: "Please hold for Dr. Wokemeup."

(pause, bad music)

Dr. Wokemeup: "Hi, Grumpy?"

Dr. Grumpy: "What's up?"

Dr. Wokemeup: "Do you know a patient named Mr. Headbleed?"

Dr. Grumpy: "No, doesn't sound familiar."

Dr. Wokemeup: "I didn't think you would. He's visiting from out of state, and says he doesn't have any local docs. Anyway, it doesn't matter. At the family's request we're transferring him to Major Neurology University Medical Center. Thanks for returning my call."

I'm on call this weekend, but am going to bitch about something unrelated.

A friend died last week. Not a close friend, or even someone I'd talked to recently. We did residency together, and practiced in the same city. But as time and geography do, we hadn't been in contact for a while. Not that we ever had a falling out, as much as we had our own lives. Occasionally we ran into each other at various places, and it was always good to see him.

He died of shit luck. That's all. And he was in his early 40's, a year younger than me. When a young person dies we always hope they did drugs. Or committed suicide. Or some risky behavior we can blame it on so we can say, "Geez, I don't do that sort of thing, so it won't happen to me". Not here. Just shit luck that can't really be prevented.

In residency we had all kinds of odd adventures, besides the usual war stories of medical training. Like when our hospital paid for the residents to go to a Neurology Academy meeting in Seattle. A bunch of us played hookie, and used our department stipends to go barhopping. Since we had no money for cabs, we were limited to bars in walking distance from our cheap motel. And they were all gaybars. So we wandered in and out of 10-15 gaybars over the course of the day.

All the geeks in neurology residency (let's face it, that was all of us) would watch Babylon 5 together once a week, and he and I would argue about it for the next week.

When I was trying to decide if I should ask Mrs. Grumpy to marry me, he gave me some advice that helped push me in what's turned out to be the right direction.

And it just sucks. Like me, he busted his ass through a combined 14 years of college, med school, residency, and fellowship. Then building a solo practice from scratch. And now he leaves behind a wife and 4 kids (younger than mine, too).

Anyway, don't mean today to be a downer, and I'm not looking for sympathy. Just venting.

But since this is a humor blog, I'll end it with a memory of him.

He was known for being gruff, and didn't really give a shit about what people thought of him or who he offended.

There was a day in the late 90's, when a drug rep had brought lunch to the practice we'd both started out in. She was obnoxious beyond belief. She would not shut up. And at the end of each sentence she'd ask "With this information, is there anything else I can do to help improve your patient care?"

We were trapped. And being new physicians, I was afraid that if we walked out we'd get in trouble, as her company was sponsoring some research at our institution. Gruff wasn't as concerned with this as I was.

So at one point in her sales monologue from hell, I passed him a note that said "We're trapped and will die here". He passed it back, and had written "I'll take care of it".

A second later she asked her standard "With this information, is there anything else I can do to help improve your patient care?"

Friday, October 16, 2009

Ladies and Gentleman, one of the most horrible, awful, traumatic diseases in history HAS BEEN CURED!

Kapidex is a rehash of Prevacid, a drug used to treat gastric reflux (that's a fancy name for heartburn, huh?)

But Kapidex also treats Non-Erosive Reflux Disease. AKA NERD!!!

(click to enlarge)

There you go! Nerdhood, one of the most socially debilitating diseases known to man, has been CURED!

To give credit where credit is due: this breakthrough wouldn't have been possible without the 1970's efforts of renowned researchers H. Winkler and A. Fonzarelli to bring the condition to widespread public attention.

The data is preliminary, and hopefully more information will be forthcoming. Will the drug cause one to grow a leather jacket? Or make hair follicles part themselves differently? Or alter one's taste in music to something other than "Men Without Hats Greatest Hit?"

And, most importantly, can the drug be dissolved in Diet Coke (uh, not that I'd personally have a reason to want to know that).

When the kids were younger, we had a part-time nanny named Syndee. I was anything but fond of her. I don't remember how Mrs. Grumpy found her.

Syndee did a good job with the kids, so I turned a blind eye to her many shortcomings (which could be several posts alone). Her main issue was a remarkable lack of IQ and common sense. It was not uncommon to realize she'd been outsmarted by Snowball (and he's slow). She occasionally still calls to see if we need a babysitter. Rarely she'll call me for medical questions, as she does not grasp the concept of what being a specialist means. She's also learned (since she knows our home number) that it's easier to reach me then her own doctor.

Last week Syndee got married, and went off to Hawaii for her honeymoon.

This morning, at 12:05 a.m., I was woken by our home phone ringing.

Dr. Grumpy: "Mmmph, hello?"

Syndee: "Hi! Dr. Grumpy! It's me, Syndee!"

Dr. Grumpy: "What the hell?... Syndee do you know what time it is?"

Syndee: "Sure! It's just after dinner! Why, is your clock broken?"

Dr. Grumpy: "No, it's after midnight here."

Syndee: "It is not! I wouldn't call that late!"

Dr. Grumpy: "Syndee, you're in another time zone."

Syndee: "What's a time zone?"

Dr. Grumpy (sigh): "Why did you call Syndee?"

Syndee: "Well, um, In the last few days I've developed a bladder infection and..."

Dr. Grumpy (seeing an opportunity to get even): "What the HELL have you been doing on your honeymoon to get a bladder infection?"

Syndee: "Well, um, my husband and me, um we, um... Can you just call in some antibiotics for me?"

A rep for a Parkinson's Disease drug dropped off an invite this morning (I'd put it up, but it was so full of potentially identifying info that I couldn't adequately censure it without ruining the effect, so you just get a summary).

It was an invitation to attend the "Park-toberfest" celebration.

Featuring:

"Opportunities to mingle with Parkinson's patients and their families" (I already do this at work!)

Saturday, October 10, 2009

A group of 8 came in, and were seated near us. They provided the entertainment for the evening. Mrs. Grumpy knows it's a bad sign when I start taking notes.

They'd never had Thai food before, and found the menu befuddling. One lady asked where the hamburger section of the menu was. Another was under the impression that all Thai food was like the Thai chicken pizza he gets at California Pizza Kitchen, and began arguing with the wattress about "how come you don't have pizza! You're a Thai restaurant for Pete's sake!"

After a woman at one end of the table ordered something, the waitress asked if she wanted rice or noodles with it. The woman, I swear, said "Um, I don't like either. Can I get some Doritos instead?"

But the best part came when their conversation turned to healthy eating. One woman wanted to know why no one had invented a pill that blocks caffeine. That way you could have a Coke, and take this pill, and not have the effects of caffeine. Obviously, drinking caffeine-free Coke was too complex for her.

AND THEN I heard the name of one of my stroke patients. It was something like this:

"How's Phil doing?"

"Oh, he's okay. You know how Phil is. He's just ignoring advice and trying to do this on his own."

"I thought he was in rehab?"

"He is, and those idiot doctors are doing physical therapy and other stuff, like that's going to help. I went by and gave him a bunch of info on how all he really needs to do is take some vitamin B6 and ginger tea to get his left side working again, but he won't listen to me. He acts like these doctors know what they're doing."

"Hi, this is Mr. Noclue. I have an appointment with Dr. Grumpy today, and I'm not going to make it because I have another appointment and, what?..........Oh, my wife says today is Saturday, and my other appointment is next week, so I guess I will be able to come see you today............ my wife says you're probably not open on Saturday either, so I'm going to go find my calendar to see when my appointment is and will call you back".

Wednesday, October 7, 2009

A common method of non-urgent hospital communication between doctors and nurses is the post-it note. I'll open a chart, and find a post-it in the progress notes saying: "Dr.- Can patient take his fish oil pills from home?" or "Dr.- Patient says she also takes Synthroid. Can you please order this?"

So this afternoon on rounds I found the following note in one of my hospital patient's charts. (NOTE- for my non-medical readers, PRN means "when needed")

Look, folks. I understand that your back pain started sometime during your 6 week "Drive our big-ass RV all over the damn country across 28 states and 5000 miles trip."

However, without a clearer idea of WHEN you were WHERE, or having an idea of your intinerary, telling me things like "the problem started in Georgia, though maybe it was there in Ohio, and was definitely worse by Texas" is NOT a lot of help.

As my regular readers know, I moonlight as a consultant for various medical market research companies. It's a thankless job, but somebody has to pay for the tomatoes.

So last night I had a dinner meeting with neurologists and sundry other specialists to review data on an up-and-coming product.

These are never fun, because neurologists by nature are a remarkably pathological group of personalities. Back when I worked at Humungous Neurology, Inc. the partners would argue if it was dark or light outside. I think they invite the other specialties to these as a buffer.

But I digress.

So I was seated next to Dr. Harangue, who I'd had the good fortune of not having seen in at least 5 years. In his own mind he's a giant in his field. To those outside his mind he's an obnoxious boil. He may have once been a good doc, but as they say in Hollywood "you're only as good as your last picture". And his was made before Casablanca.

Neurologists will argue over anything. The meal started with a dispute across from me over who's bread plate was who's (right or left? GET YOUR BREAD OFF MY PLATE!) followed by a fight over which fork is used for salad. Somebody actually dragged the maitre d' to the room to settle the issue (no, it wasn't me. I sit still and keep my mouth shut as much as possible).

I'm not much into the swanky places they have these meetings at. I ordered a steak. I had no idea how complex this was.

Waiter: "How would you like that cooked?"

Dr. Grumpy: "Medium."

Waiter: 'That involves a light red center. Is that okay?"

Dr. Grumpy: "As opposed to..."

Waiter: "Well, rare is a pink center."

Dr. Grumpy: "Medium is fine."

Waiter: "I can do medium rare, too. That's a pink/red combo".

Dr. Grumpy: "What's wrong with medium?"

Waiter: "I'll just do medium-rare-plus for you. That's a pinkish-red."

Whatever. I'm trying to order a steak, not pick out draperies.

Then the talk began. Every time a doc involved in the study was mentioned, Dr. Harangue felt the need to interrupt and say "I know that doctor personally. We've been close friends for over 25 years." By the end of the meeting I was hoping they'd mention a study done by Hippocrates or Woodrow Wilson to see if he knew them, too.

After 15 minutes of talking, the speaker stepped out from behind the podium to show us all that his zipper was down, with his tucked-in shirt hanging out of it. A tactful internist promptly yelled "Christ! Your fly is open!" to drop a subtle hint.

Then they brought dinner. The cardiologist next to me had ordered prime rib (no comment), and the waiter accidentally set my steak in front of him, and his prime rib in front of me. I pointed this out, and he quickly switched plates.

The cardiologist had a freakin' FIT! "I don't want that now! It was in front of him! He could have H1N1, or worse! Doesn't the heath department check you places anymore?!!!" It was, literally, in front of me for less than 5 seconds.So I quietly started my steak, while they went to get Dr. Germaphobe a new prime rib (actually, I think they just brought him back the old one).The next speaker showed us a seemingly endless series of graphs. After 20 minutes of this, she asked if anyone had any comments. Dr. Phlame at the end of the table immediately raised his hand. "Yes, I want to know why you chose red and blue as the main colors for the graphs. I think mauve and maybe yellow would be much more aesthetically pleasing. Also, I think some ruffles or curvy lines around the slide border would be nice."

This was immediately followed by Dr. Harangue chipping in "Dr. Phlame, do you live under a freaking rock? This company has been using those colors for years. But back to the data, did any of you people think to compare these results to a 1954 study by Longdead, et al?" The speaker (and everyone else there) had absolutely no clue what he was talking about, and Dr. Harangue chewed us out, as if it had just been published last week. When I looked it up, the study investigated a drug (that's no longer in use) for an unrelated condition.

Throughout this excitement the waiters kept refilling our glasses (ENDLESS DIET COKE HEAVEN!), so dysfunctional personalities were not improving with repeated doses of Burgundy and other wines.In one discussion, to argue a point about a competing drug, an internist actually reached into his pocket and pulled out a product insert. I swear! He had it with him, all scrunched up. After reading from it like it was a bible he sat down and began arguing with a pulmonary doc about when daylight savings time starts.We made it through another 15 minutes of polite discussion before Dr. Germaphobe cardiologist began tapping my shoulder. "Hey, Ibee!"

I turned around "What's up?"

"Are you gonna finish your roll?"

Stunned, I looked at the bread roll I'd absently left on my plate. It was buttered, and I'd taken a few bites out of it. "Uh, no, I'm full".

"Thanks!" And he grabbed it. So the guy who'd refused to eat an untouched steak was now chomping on my partially eaten dinner roll. Amazing what a bottomless glass of white wine will do.

As we sat through another set of slides, Dr. Harangue's cell phone rang. He answered it, speaking loudly enough to be heard in the next county (i.e., his usual volume). "What? Yeah. No, I've got another half hour of this shit. The drug company people won't shut up."

The dinner ended 20 minutes later. To make sure all points were covered, the moderator specifically asked "Dr. Harangue, are there any other comments?"

No answer. It was the only time he'd been quiet all night. He was in a burgundy stupor, slumped face down next to his creme brulee. He was still there when I collected my paycheck and left.

"Since my injury I haven't been able to go hunting, which used to be one of my favorite things. I found out that the state has a program for disabled deer hunting. Could you please complete the attached forms to let me participate in this?"

I hope this is simply a misplaced adjective, and not some bizarre new state program.

I have no idea who had it before. But apparently she was quite active in doing monthly breast exams. So much so that she subscribed to a phone service (run by a local celebrity) to remind her.

So, for the last 9 years, on the 5th day of each month, at 8:00 p.m. sharp (who picked that time?) when the office line is rolled over to my cell phone, I always get this recorded message: "Hi! This is Pamela Perky! Calling to remind you that it's time to do your monthly breast check! And call a buddy, and remind her to do it, too!"

I once called the service. They refused to take me off the list, since I didn't know the name of the original subscriber.

We decided to get passports, in case we go on a cruise next Summer. They're now required, so we figured we ought to get them now rather then wait till the last minute.

My last passport is long gone. I got it in the early 80's, when I was 15, for the generic American-Family-Goes-to-Europe trip. I have no idea where it is. It may be buried in a box at my parents' house. Or in my closet. Or lost/tossed in one of my countless moves between college, medical school, residency, marriage, etc. It had a hideous photo of me with early 80's shoulder-length hair, thick plastic rim glasses, braces, and zits.

So we made an appointment to do this over at our local post office yesterday. The girl is typing in our social security numbers. When she gets to mine she stops, and stares at the computer screen.

Ms. Postal: "Mr. Grumpy, are you aware there's already a passport in existence for this number?"

To be honest, I'd forgotten about it until she said that.

Dr. Grumpy: "Oh, yeah, that was from the early 80's. I'm sure it's long expired."

Ms. Postal: "May I have it please?"

Dr. Grumpy: "I don't have it. I have no idea where it is."

Ms. Postal: "WHAT! DO YOU REALIZE HOW IRRESPONSIBLE THAT IS?!!!"

Dr. Grumpy: "Uh, no, I mean, I'm sorry..."

Ms. Postal: "There could be a TERRORIST out there somewhere right now! Using your name, picture, and passport!"

(If Al-Queda has operatives out there who look like I did in the early 80's, I sort of feel bad for them).

Dr. Grumpy: "I'm really sorry, I didn't know I needed it."

Ms. Postal: "WELL! I guess I'll just have to mark the box here for previous passport lost. And let's hope that's ALL that's happened to it."

Dr. Grumpy: "Thank you. I'm sorry."

Ms. Postal: "Let's just try to be more careful with your new passport, shall we?"

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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Note: I do not answer medical questions. If you are having a medical issue, see your own doctor. For all you know I'm really a Mongolian yak herder and have no medical training at all except in issues regarding the care and feeding of Mongolian yaks.